Segment 9 - Challenges of Prior Authorization and Patient Access to RA Drugs

The panelists concluded the discussion by analyzing the concept of a cost-sharing option for patients with RA. Conceptually, their out-of-pocket costs for certain medications would be based on their medication history.

The panelists concluded the discussion by analyzing the concept of a cost-sharing option for patients with RA. Conceptually, their out-of-pocket costs for certain medications would be based on their medication history.

Dr Ruderman said he feels that the cost-sharing concept is both ideal and feasible, especially because both providers and payers can track how well a patient’s response to a certain drug. Right now, he said, the barrier seems to be cost. He also said there is an ongoing challenge with prior authorization.

“There’s an ongoing issue of prior authorization for these expensive drugs that really feels in many ways like jumping through hoops. And it’s simply driven by cost, and then it’s every year,” said Dr Ruderman. “I have patients who, annually, spend a month without their drug because we’re trying to go through the hassles of trying to getting reauthorized for another year. That makes no sense from a clinical care standpoint.”

He added that stakeholders cannot expect patient health outcomes to improve if patients cannot afford or access the medications they need.

Dr Fendrick concluded by thanking the panelists for their participation, saying that stakeholders should feel encouraged as providers and payers move toward implementing cost-saving changes that will drive adherence in patients with RA.